The process of dying is a ubiquitous milestone that allows patients and family members a time of reconciliation, growth, and spiritual enrichment as life enters its final chapter (Rousseau 1999; Cherny 1994). Lamentably, it can also be a time of considerable suffering, precipitating physical and emotional anguish and fomenting desperate and unnecessary requests for physician-assisted death.

Even though symptoms can be adequately managed in most dying patients, suffering in all its domains may be refractory to standard palliative measures. When such suffering occurs, the goals of care are often modified so that the relief of symptoms may prevail over all other considerations, including the maintenance of consciousness. For that reason, when palliative therapies have been exhausted and symptoms remain refractory, palliative sedation is a valuable therapeutic adjunct that affords a more comfortable and dignified death (Rousseau 1999).

Nevertheless, palliative sedation remains somewhat contentious, due to lack of a consistent and universal definition, disparity in clinical use, ethical and moral apprehensions, confusion regarding sedative medications, and a paucity of well-controlled research.

After completing this module you will be able to:

1. Define palliative sedation.
2. Define refractory symptoms.
3. Describe the criteria for deciding to institute palliative sedation
4. Describe the ethical issues and legal precedents for using palliative sedation.
5. Describe psychological suffering.
6. List the medications that are preferred for palliative sedation and describe why they are preferred.